Lumbar Microdiscectomy

Many people with a herniated lumbar disc will improve with time, therapy, injections, manipulation, or a combination of these. Occasionally, however, these standard treatments fail to relieve the symptoms in a timely manner. For these individuals, surgery is sometimes an option.

The goal of lumbar microdiscectomy is to remove any material that is pushing on the nerve root which is causing symptoms. This can be done in a variety of ways, but the principle remains the same. Generally, a small incision is made at the level of the disc problem. The muscles are lifted away from the lamina (bone covering the nerve roots). The lamina above and below are connected by a ligament called the ligamentum flavum. This ligament is elevated from the bone and either partially or completely removed. Generally, some of the lamina is also removed which is called laminotomy. With the ligamentum flavum removed, the dural sac (lining around the nerve roots) is exposed.

This can then be gently retracted to expose the disc material that has been pushed out of the disc space. Sometimes, a small cruciate incision is made in the lining over the disc material to create an opening to remove the disc. The loose material is removed from the spinal canal and the area is checked with special tools to make sure there are no other areas where the nerve root is being compressed. Some surgeons will also probe into the disc space itself in order to make sure there is no more loosened or free disc material that may slip out again. Once satisfied that there is no longer compression of the nerve, and that all the loose disc material has been removed, the surgeon will wash the area thoroughly and then close it with sutures. I prefer to use sutures that are buried under the skin to avoid the need for removal later.

Most commonly, people are allowed to return home the same day as their surgery, although some surgeons prefer to have them spend the night at the hospital. I ask my patients to “take it easy” for the next 6 weeks, which means no lifting more than 10-15 lbs, and no activities that could put extra strain on their back such as golf, horseback riding, running, etc. Sitting for long periods of time is also uncomfortable, so if the person’s job requires sitting, I request that they get up and walk around every 15 minutes or so.

After 6 weeks, if all has gone well, I relax the restrictions and allow the patient to slowly return to activities they enjoy. Sometimes symptoms can return briefly, and in those cases, all that is usually required is slowing down again for a short time to let the symptoms improve.